Government of Odisha
Revenue & Disaster Management Department
FORM No.25
APPLCATION FOR CONVERSION OF AGRICULTURAL LAND FOR NON AGRICULTURAL PURPOSE
All * fields are mandatory
Name of Raiyat :
Father's/Husband's Name :
Present Address
Village/Town :
Address :
District :
State :
Pin :
Email Id:
Mobile :
Specific purpose for which the land will be utlized after conversion:
Particulars of land
District:
Select District
Angul
Balangir
Balasore
Bargarh
Bhadrak
Boud
Cuttack
Deogarh
Dhenkanal
Gajapati
Ganjam
Jagatsinghpur
Jajpur
Jharsuguda
Kalahandi
Kandhamal
Kendrapara
Keonjhar
Khurda
Koraput
Malkangiri
Mayurbhanja
Nabarangpur
Nayagarh
Nuapada
Puri
Rayagada
Sambalpur
Sonepur
Sundergarh
Tahasil:
Village:
Khata No :
Classification and status as per current R.O.R :
Whether the land is situated in any area within 0.5 km on either side of National Highway or 0.25 km on either side of state Highways :
Yes
No
Situation of land :
Municipal Corporation
Municipality
NAC
Developing Area
Rural Area
The land is intended to be used /already used for non agricultural purpose:
Already Used
Intended to be used
Source of Ownership:
Approximate market value of the land:
Do you want exemption from payment of conversion Fee as per any state Govt. policy :
--Select--
Yes
No
I do hereby declare that I have enclosed the relevant documents and indicated the details of land for conversion. I am willing to pay necessary fees as will be determined.
Enter Captcha :
Application Details
District :
Tahasil :
Application No. :
Date :
Applicant Name :
Father's/Husband's Name :
LAND SCHEDULE
N.B: Please quote the Application No. for future correspondence.
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